MLSA Membership Application Form

Name of Applicant(s)*
First Last
Company Details*
Business Name ABN Trading As
Business Mobile*
Email*
Registered Business Address*
Street Address City State / Province / Region ZIP / Postal Code
Alternate Mailing Address
Street Address City State / Province / Region ZIP / Postal Code
Business Landline
After Hours Phone
Website

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Is your business a:*
- Sole Trader
- Partnership
- Incorporated (Pty Ltd)
- Family Trust
- Other
Number of years:*
In the landscaping industry In business
Number of Staff (full-time equivalent)*
Services provided by your business that you are licensed or qualified to perform (e.g. 'paving'; 'landscape design' etc.)*
Details of Directors/Partners/Principals*
First Name Last Name Contact Number
Details of Accounts Payable Contact*
First Name Last Name Contact Number Email Address

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Nominated Membership Category*
- Commercial Landscaper (>30% of total)
- Residential Landscaper (>30% of total)
- Landscape Designer
- Landscape Designer with Supervisor's License
- Garden Maintenance
- Industry Supplier
- Student
Referee 1: a Client*
First Name Last Name Contact Number
Referee 2: an Industry Supplier*
First Name Last Name Company Name Contact Number
Referee 3: a General Referee from the Industry*
First Name Last Name Company Name Contact Number
Builder's Licence Number
Please upload a copy of your current Contractor's License, showing scope of registration.
Other Relevant Licenses Held
Please upload a certificate of currency for your business insurance policy.
RTO or Institution attended to achieve the above qualifications

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Do you give MLSA your authority to supply the general public with your business contact details, along with an indication of the services provided by your business?*
- Yes
- No
Declaration:*
- I hereby make an application for membership to the Landscape Association of South Australia Inc. trading as Master Landscapers of SA (MLSA). If accepted, I understand that MLSA will enter my name onto the member registry available for public access. I agree to be bound by the MLSA Constitution, rules and by-laws made thereafter and abide by the MLSA Code of Conduct.
Email
This field is for validation purposes and should be left unchanged.

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Business Name	ABN	Trading As

In the landscaping industry	In business

First Name	Last Name	Contact Number

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